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    Preeclampsia Awareness Month

    Spencer Kuper, MD Maternal-Fetal Medicine, Tri-State Perinatology at The Women's Hospital 05/04/2020

    May is Preeclampsia Awareness Month. Many may recognize the diagnosis, sometimes called toxemia, as the cause of a dramatic turn of events in the popular PBS drama “Downton Abbey.”

    One of the main characters, Lady Sybil Crawley, is in labor with her first child. The family’s doctor explains that Sybil has preeclampsia and is in danger. He recognizes the signs of the complication; she has protein in her urine, her ankles are swollen, and her baby is small. The next scene transitions to Lady Sybil delivering a beautiful baby girl; unfortunately, as fans recall, she experiences a seizure which is a rare complication of preeclampsia and dies. In fact, preeclampsia is the leading cause of maternal death during pregnancy worldwide.

    Preeclampsia affects up to five percent of all pregnant women. Thankfully, doctors watch closely at each prenatal visit for signs and symptoms of preeclampsia by measuring blood pressure, checking to see if protein is present in the urine sample and asking about symptoms of preeclampsia.

    Experts do not completely understand the cause of preeclampsia but they believe it to be from abnormalities in the placenta that lead to changes in the blood vessels and nerves throughout the body including the  kidneys, liver, skin, and brain to name a few. The most common signs of preeclampsia are swelling, high blood pressure, and protein in the urine. Other concerning signs and symptoms are headaches that are not relieved by Tylenol, vision changes such as blurry vision or seeing double, and pain in the right upper part of the abdomen where the liver is located. A severe presentation of preeclampsia that can be especially life threatening to both mother and baby is called HELLP syndrome.

    Preeclampsia can occur at any point past 20 weeks of gestation but most commonly occurs towards the end of pregnancy. Sadly, despite numerous advances in obstetrics, a treatment for preeclampsia besides delivery has yet to be found. Since the only treatment is delivery, the goal is to prolong the pregnancy while balancing the shared risks to the mom and baby. Sometimes this involves starting blood pressure medications to decrease the risk of the mom having a stroke or the placenta separating from the uterus. There are situations where preeclampsia is called “severe,” such as when the blood pressure is very high, which may require that the baby be delivered early. In fact, if HELLP syndrome or eclampsia (seizures) occurs, delivery is recommended regardless of how far along the pregnancy is. If delivery is needed before term, steroid shots may be given to reduce the risk of complications for the baby. Experts do not recommend extending the pregnancy beyond 37 weeks in patients with preeclampsia because the risks to the mom and baby outweigh the risks to the baby of being born before the due date. 

    There are several conditions that place a pregnant woman at an increased risk of developing preeclampsia during pregnancy. The most common are a history of  high blood pressure, preeclampsia in a prior pregnancy, diabetes mellitus, obesity, first pregnancy, age ≥ 35-years old, multiple gestations (twins, triplets, or quadruplets), and autoimmune diseases such as lupus. Recent studies have found women who take a baby aspirin (81 mg) on a daily basis have a lower risk of developing preeclampsia during pregnancy. Therefore, all patients at increased risk of developing preeclampsia during pregnancy should take a baby aspirin in addition to a prenatal vitamin.

    Preeclampsia is one of many conditions where your doctor may refer you to see a high-risk pregnancy specialist. A high-risk specialist, sometimes called a Perinatologist or a Maternal–Fetal Medicine Specialist, has additional training in providing care to women with high-risk pregnancies. A few conditions other than preeclampsia that may prompt a high-risk referral are diabetes, high blood pressure, multiple gestations (twins, triplets, or quadruplets), a prior child born before 37 weeks, a family history of genetic conditions, a history of a prior child with a birth defect, or an abnormality identified on an ultrasound.  If you or a friend of yours has a high-risk pregnancy, ask about being referred to see a specialist at Tri-State Perinatology at The Women’s Hospital. 

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